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Functional Luminal Imaging Probe in the Management of Pediatric Esophageal Disorders
Olivier Courbette1, Colette Deslandres, Éric Drouin
1Division of Pediatric Gastroenterology, Sainte-Justine Hospital, Montréal, Québec, Canada.
Insights
Functional luminal imaging probe (FLIP) is safe and feasible in children with esophageal disorders, guiding management in 47% of cases. This technique helps differentiate causes of dysphagia, improving patient outcomes.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
Background:
- Functional luminal imaging probe (FLIP) assesses esophageal pressure-geometry relationships.
- Limited data exists on FLIP's utility and standardized use in pediatric populations.
- Understanding pediatric esophageal pathophysiology requires advanced diagnostic tools.
Purpose of the Study:
- To evaluate the safety and feasibility of FLIP in pediatric patients with esophageal disorders.
- To assess the clinical impact of FLIP on the management of pediatric dysphagia.
- To establish standardized FLIP protocols for children.
Main Methods:
- Retrospective chart review of consecutive FLIP recordings from February 2018 to January 2021.
- Inclusion of pediatric patients with various esophageal conditions.
- Evaluation of post-procedure symptomatology using validated dysphagia scores.
Main Results:
- Nineteen pediatric patients (median age 16 years) with conditions including achalasia, post-surgical dysphagia, and stenosis were included.
- FLIP's distensibility index (DI) differentiated between obstructive and non-obstructive dysphagia, guiding dilation.
- Management was altered in 47% of patients, with 47% becoming symptom-free.
Conclusions:
- FLIP is a valuable tool for assessing pediatric esophageal disorders.
- It provides crucial luminal parameters for understanding pathophysiology.
- FLIP can significantly impact clinical management and improve outcomes in children with dysphagia.
Background:
Functional luminal imaging probe (FLIP) measures pressure-geometry relationships of digestive luminal space. When used in esophageal disorders, it provides several luminal parameters that help better understand the pathophysiology. Data about the potential utility of FLIP in pediatrics are scarce and there is no standardized use in children. We aim to describe the use of FLIP in our center, its safety, feasibility, and clinical impact in esophageal disorders in children.
Methods:
Consecutive FLIP recordings performed at the Centre Hospitalier Universitaire-Sainte-Justine, Montréal, Canada between February 2018 and January 2021 were extracted. A chart review was conducted for demographics and medical history. Symptomatology after the procedure was evaluated with validated dysphagia scores.
Key Results:
Nineteen patients were included (11 girls, median age 16 years, range 3.2-19.6) with achalasia (n = 5), post-Heller's myotomy dysphagia (n = 3), esophagogastric junction outflow obstruction (n = 3), congenital esophageal stenosis (n = 2); post-esophageal atresia repair stricture (n = 3), and post-fundoplication dysphagia (n = 3). There was no significant correlation between integrated relaxation pressure measured with high resolution manometry and distensibility index (DI). The use of FLIP made it possible to differentiate between dysphagia related to an esophageal obstruction (DI < 2.8 mm2/mmHg) and dysphagia without major motility disorder (DI > 2.8 mm2/mmHg) that guided the indication for dilation. FLIP led to a change in management in 47% of the patients. Forty-seven percent of the patients were symptom free at the time of the evaluation.
Conclusions Inferences:
FLIP provides key esophageal luminal values and therefore can play an important role in pediatric esophageal disorders management.
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